Treatment of Local Ischemia Due to Levarterenol (Levophed) Leakage With Piperoxan

Pelner, Louis

doi:10.1001/jama.1957.02980230014004

Cited by 14 publications

(4 citation statements)

References 6 publications

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“…3 When faced with peripheral tissue ischemia, the only described treatment consists of reversing the vasoconstrictive process with vasodilators, applied either topically 4 or subcutaneously. 5 Local infiltration with piperoxan (an ␣-adrenergic antagonist) has also been used with good results. 5 On the other hand, stellate ganglion block, by virtue of the sympathectomy it creates, is a recognized treatment for many cases of upper-extremity complex regional pain syndrome (CRPS).…”

Section: Discussionmentioning

confidence: 99%

“…5 Local infiltration with piperoxan (an ␣-adrenergic antagonist) has also been used with good results. 5 On the other hand, stellate ganglion block, by virtue of the sympathectomy it creates, is a recognized treatment for many cases of upper-extremity complex regional pain syndrome (CRPS). 6 It has also been used with good results to improve distal circulation in patients with systemic sclerosis 7 and in premature infants.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

Tran

Finlayson

2005

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

Tran

Finlayson

2005

Regional Anesthesia and Pain Medicine

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“…No systemic alteration of the pressor effect has been noted when the two were given simultaneously.1"11 Piperoxan (Benodaine) hydrochloride injected locally has been reported to be as effective as phentolamine. 12 Saline, histamine, procaine hydrochloride, hyaluronidase, papaverine hydrochloride, sympathecto¬ my, and intravenous infusion of phentolamine are ineffective in preventing sloughs after levarterenol extravasation.9…”

Section: Commentmentioning

confidence: 99%

Ischemia of the Hand Secondary to Levarterenol Bitartrate Extravasation

Weeks¹

1966

JAMA

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“…"4 Of the more serious adverse effects thrombocytopenia has been reported in two instances; leukopenia, hemolytic anemia, and focal hepatitis each has been reported once. 5 Four fatalities have been reported after sulfamethoxypyridazine administration, one from aplastic anemia 6 and three from "hypersensitivity myocarditis." 7 In one of the latter fatalities the myocardial changes were thought to be only a contributing factor, while in two they were assumed to be the direct cause of death.…”

Section: Grenous Commentmentioning

confidence: 99%

Ischemic Necrosis Due to Administration of Metaraminol

Shaub¹

1960

JAMA

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The use of sympathomimetic amines, such as arterenol (Levophed) bitartrate and metaraminol (Aramine) bitartrate, as vasopressor agents in the treatment of clinical hypotension has received widespread acceptance. The occurrence of ischemic necrosis secondary to the administration of arterenol has been well documented.1 Due to the physiological similarity of these drugs it could be expected that such a complication would arise with extensive use of metaraminol. One such case was reported recently.2 The following is a report of a similar case.A 62-year-old man was admitted to the Latter\x=req-\ day Saints Hospital on April 17, 1959, with the type of electrocardiographic changes found in patients with acute, posterior myocardial infarction, a white blood cell count of 11,200 per cubic millimeter, and a serum transaminase level of 56 Todd units. At the time of admission the patient's blood pressure was 130/100 mm. Hg in both arms, and his pulse rate was 60 per minute and regular. On the third hospital day the patient suddenly became unresponsive. Neither respirations, pulse, nor blood pressure could be obtained. Artificial respiration was instituted, after which the patient began Cheyne-Stokes respirations. He was given, intravenously, 2 cc. of methoxamine (Vasoxyl) hydrochloride and 2 cc. of nikethamide (Coramine). An intravenous infusion of 50 mg. of metaraminol diluted with 5% dextrose in 1,000 cc. of water was started in the right antecubital vein. The heart sounds once more were audible, but were noted to be irregular. An electrocardiogram showed varying degrees of atrioventricular block, with a ventricular rate of 60 per minute.The intravenous infusion infiltrated after 16 hours, and a cut-down was done in the right greater saphenous vein. Since, because of vasospasm, a polyethylene catheter could not be inserted, an 18-gauge needle was tied in and left in place. Because of the appearance of bilateral basilar rales the patient was digitalized with 1.2 mg. of intravenously given lanatoside C (Cedilanid) over a 6-hour period. The infusion dose of metaraminol was increased to 100 mg. diluted with 5% dextrose in 1,000 cc. of sterile water and given at a rate of 30 drops per minute. On the fifth hospital day the patient's blood pressure was 90/60 mm. Hg and the pulse rate 44 per minute, with a 2:1 atrioventricular block. There was noted to be an area of discoloration extending proximally from the site of the cutdown. This was about 11 by 8 cm., with a bluish discoloration of the edges and central blanching.There were three bullous, vesicular lesions varying from 1 to 2.5 cm. in diameter. The cut-down was discontinued, restarted in the left leg, and continued until the patient's death. The site was then infiltrated with 5 mg. of phentolamine (Regitine) hydrochloride in 20 cc. of distilled sterile water; however no change was noted. The infiltrated right antecubital fossa remained normal. On the eighth hospital day the patient died. At this time it was noted that the vesicles had ruptured and the underlying tissue was ...

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Treatment of Local Ischemia Due to Levarterenol (Levophed) Leakage With Piperoxan

Cited by 14 publications

References 6 publications

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

Use of Stellate Ganglion Block to Salvage an Ischemic Hand Caused by the Extravasation of Vasopressors

Ischemia of the Hand Secondary to Levarterenol Bitartrate Extravasation

Ischemic Necrosis Due to Administration of Metaraminol

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